Psychotherapy helps many patients. The therapeutic alliance between patient and therapist is one of the most important predictors of treatment success. Though many patients are able to engage in psychotherapy without much difficulty, there is a sizable percentage of patients who are not able to establish a satisfactory working alliance with therapists and thus, do not experience much benefit. These patients may terminate prematurely from psychotherapy and be reluctant to seek further help. Because therapists have great trouble in dealing with alliance difficulties, identifying who will experience them is important. Treatment approaches and strategies need to be developed to prevent and respond to alliance difficulties. Indeed, this is the central aim of the program of research of which this study forms a part. Crucial first steps in this line of research, and the specific aims of the proposed project, include: identifying the factors that predict alliance difficulties, identifying the mechanisms by which alliance difficulties occur or are prevented, and developing assessment techniques for determining before treatment and early in treatment whether alliance difficulties are likely. Thus, in this study we propose to: (a) Assemble a set of measures which may predict alliance difficulties, considering patient, therapist, and therapy process variables; (b) Administer these measures to patients and therapists in a large, hospital-based outpatient practice, both before and during treatment; (c) Record alliance ratings from patients and therapists longitudinally and at multiple points over the course of treatment; (d) We will also gather information about whether patients terminate prematurely, as well as assess their degree of symptomatic, global, functional, and interpersonal improvement over the course of therapy; (e) Conduct analyses about which variables best predict alliance difficulties; and (f) Have patients complete an open-ended questionnaire at the end of treatment in which they are asked to identify factors that helped or hindered alliance formation with their therapist. It is hypothesized that interactions between patients' pretherapy interpersonal functioning and the interpersonal behaviors and cognitions present in the psychotherapy process will be particularly predictive of alliance difficulties. Based on the results of this study, we hope to improve our ability to predict which patients will encounter alliance difficulties in psychotherapy, and increase our understanding of how problematic therapeutic relationships develop.